Control of seizures in different stages of partial epilepsy: LACO-EXP, a Spanish retrospective study of lacosamide Vicente Villanueva a, ⁎, Francisco Javier López b , José María Serratosa c , Beatriz González-Giraldez c , Dulce Campos d , Albert Molins e , Juan Rodriguez Uranga f , José Angel Mauri g , Javier Salas-Puig h , Manuel Toledo h , Juan Carlos Sánchez-Alvarez i , Antonio Moreno j , Pedro J. Serrano-Castro k , Rosa Ana Saiz-Diaz l , Jesús González de la Aleja l , Pilar de la Peña l , Montserrat Asensio m a Hospital Universitario y Politécnico La Fe Valencia, Bulevard Sur, s/n, Carretera de Malilla, 46026 Valencia, Spain b Complejo Hospitalario Universitario Santiago, Travesía da Choupana, s/n, 15706 Santiago de Compostela, Spain c Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain d Hospital Clínico Universitario Valladolid, Avda. Ramón y Cajal, s/n, Valladolid, Spain e Hospital Universitario Dr. Josep Trueta, Av. França, s/n, 17007 Girona, Spain f Instituto de Especialidades Neurológicas (IENSA), Clinica Sagrado Corazón, Av. Manuel Siurot, 49, 41013 Sevilla, Spain g Hospital Clínico Universitario Lozano Blesa, Av. San Juan Bosco, 15, 50009 Zaragoza, Spain h Hospital Universitario Vall d'Hebrón, P. de la Vall d'Hebron, 119–129, 08035 Barcelona, Spain i Hospital Clínico Universitario San Cecilio, Av. Dr. Olóriz, 16, 18012 Granada, Spain j Hospital Universitario Son Espases, Carretera de Valldemossa, 79, 07120 Palma de Mallorca, Spain k Complejo Hospitalario Torrecárdenas, Paraje de Torrecárdenas, s/n, 04009 Almeria, Spain l Hospital Universitario 12 de Octubre, Carretera de Andalucía km. 5400, 28041 Madrid, Spain m Hospital General Universitario Alicante, Av. Pintor Baeza, 12, 03010 Alicante, Spain abstract article info Article history: Received 14 May 2013 Revised 25 July 2013 Accepted 29 July 2013 Available online xxxx Keywords: Focal epilepsy Seizure-free Lacosamide Antiepileptic drugs Retrospective study Lacosamide is approved as adjunctive therapy for focal epilepsies. The number of antiepileptic drugs (AEDs) tried is associated with prognosis. This multicenter, retrospective, observational study (LACO-EXP) in Spain in 500 adult patients with focal epilepsies examined the efficacy and tolerability of add-on lacosamide. Factors associat- ed with better efficacy/tolerability were analyzed. After 12 months, the responder rate (≥50% reduction in seizure frequency) was 57.1%, and the seizure-free rate was 14.9%. Efficacy was better when lacosamide was the first or second add-on AED, although there was a small chance to be seizure-free even for patients who had received ≤10 prior AEDs. The mechanism of action of concomitant AEDs is important in all the stages, but differences are smaller in the early stages. Lacosamide was generally well tolerated. A slower dosage–titration schedule was associated with a lower adverse event rate. Further investigation of the timing of initiation of lacosamide add-on therapy and ideal combinations of AEDs is required. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Treatment response in patients with epilepsy who have never be- fore received an antiepileptic drug (AED) is high (64% of patients became seizure-free) [1]. However, a notable proportion of patients are considered to have epilepsy that is pharmacoresistant to AEDs (about 19–36%) and continue to experience seizures [1–3]. It has been suggested that treatment response to initial monotherapy is prognostic of long-term treatment success and that few patients, after treatment with two AEDs, become seizure-free [1]. The International League Against Epilepsy (ILAE) definition of drug-resistant epilepsy seems to support this pessimistic outlook: drug-resistant epilepsy is the failure of two appropriate and adequately trialed AED regimens that can be interpreted as seizure freedom being less likely to be attained with fur- ther changes in the patient's AED regimens [4]. Recent studies have challenged this view; there is still a possibility of finding a combination that could achieve a seizure-free state in patients whose epilepsy is refractory to AEDs [5–7]. The introduction of new AEDs over the past years has favored the possibility of identifying AED Epilepsy & Behavior xxx (2013) xxx–xxx ⁎ Corresponding author at: Multidisciplinary Epilepsy Unit/Neurology Service, Hospital Universitario y Politécnico La Fe, Bulevard Sur, s/n, Carretera de Malilla, 46026 Valencia, Spain. Fax: +34 961244330. E-mail addresses: villanueva_vichab@gva.es (V. Villanueva), javieritol@yahoo.com (F.J. López), joseserratosa@me.com (J.M. Serratosa), beagiraldez@yahoo.es (B. González-Giraldez), dm04cb@hotmail.com (D. Campos), amolinsalbanell@yahoo.es (A. Molins), juanuranga@telefonica.net (J. Rodriguez Uranga), jamauri@telefonica.net (J.A. Mauri), jsalasp@meditex.es (J. Salas-Puig), mtoledo75@hotmail.com (M. Toledo), jucasan9@gmail.com (J.C. Sánchez-Alvarez), antonio.moreno@ssib.es (A. Moreno), pedro.serrano.c@gmail.com (P.J. Serrano-Castro), rsaizdiaz@yahoo.com (R.A. Saiz-Diaz), jesus_goal@yahoo.es (J. González de la Aleja), pilar_pena@yahoo.com (P. de la Peña), asensio_mon@gva.es (M. Asensio). YEBEH-03535; No. of pages: 8; 4C: 1525-5050/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.yebeh.2013.07.024 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh Please cite this article as: Villanueva V, et al, Control of seizures in different stages of partial epilepsy: LACO-EXP, a Spanish retrospective study of lacosamide, Epilepsy Behav (2013), http://dx.doi.org/10.1016/j.yebeh.2013.07.024